NCLEX Frequently Missed Topics
how long does it take for insulin NPH to peak/when is patient most at risk for hypoglycemia?
4-12 hours
how big does TB test induration have to be to be a positive TB test in a healthy patient?
>15mm in healthy individuals is positive if >10cm in immunocompromised then positive >5 if have HIV or were exposed to TB
T/F: to prevent constipation, clients should avoid caffeine and avoid using laxatives unless prescribed by provider
TRUE should increase fluids, fiber in diet, activity level, go when feel the urge
T/F: an AED can still be used if client is damp on body or lying in shallow pool of water
TRUE - just need to wipe of chest and remove any medication patches on skin
T/F: someone who is undergoing brachytherapy in the hospital's body fluids are able to be disposed of normally and flushed down toilet
TRUE - urine is not considered radioactive
how is HIV spread?
when nonintact skin comes into contact with infected blood, breast milk, semen, vaginal secretions
how long does it take for insulin lispro to peak?
works in 15-30 mins
when should pap tests be started?
age 21, regardless of sexual history
what does emphysema in COPD even mean?
air trapped in the alveoli - dyspnea, barrel chest, hyperresonance on percussion
placenta previa looks like
bright red bleeding, PAINLESS do not do digital cervical exams
where should you look for petechiae in AA patient with DIC?
bucal mucosa and conjuntiva of eye
a nurse is caring for a patient with DIC. which locations would be to assess for presence of petechiae?
buccal mucosa and conjunctiva of eyes
which hand do you don with sterile glove first?
dominant first then non-dominant
for a client with restraints, how often should you remove them and perform passive range of motion exercises?
every 2 hours
how often should an ostomy appliance and bag be changed?
every 5-10 days
how often should nurse reassess need for restraints?
every hour - should be removed ASAP
blood products should not be left at room temp for > ___how long?______________
for longer than 30 mins - they should be returned to blood bank
what supplements should patients avoid if taking blood thinners?
ginger, garlic, gingko, ginseng, saw palmetto
what does a negative stress test mean?
has no late or variable decelerations and is associated with good fetal outcomes
erikson stage for school age, adolescence, young adult
industry vs inferiority identity vs role confusion intimacy vs isolation
when a medication has been knowingly withheld by a nurse what is the first action a charge nurse should take?
instruct nurse to notify provider and
what is brachytherapy?
internal radiation treatment that is ingested, injected into cavity or bloodstream or implanted (seeds), it emits radiation in or near tumor
foods high in potassium
legumes, potatoes, beef, leafy greens, dried fruit, melon, avocado, oranges, bananas, strawberries, milk, most fish, whole grains, granola, bran
car seat rules for infants
must be rear facing until age 2 secured beneath armpits 45* angle
ectopic pregnancy may present with
shoulder pain
what is osteomalacia?
softening of the bones, typically through a deficiency of vitamin D or calcium.
what type of medication has greatest potential for increasing lithium's concentrations?
thiazide diuretics they also interact with NSAIDS (ibuprofen and antidepressants)
after a gastrectomy, how long should a client be kept NPO?
until bowel sounds return
A client with sickle cell crisis should be given what priority intervention first in vasoocclusive crisis?
high flow IV fluids - inadequate oxygenation and fluids causes crisis and ischemic pain/hypoxia hydration may reverse sickling
what lab abnormalities does the oncological emergency of tumor lysis syndrome cause?
hyperkalemia hypocalcemia hyperphosphatemia avoid loop diuretics (K sparing ones)
what are the sx of thyroid storm?
hyperthyroid crisis - fever, tachycardia, N/V, ams
what is priority teaching topic in a 15 yo first prenatal visit at 12 weeks pregnant?
importance of consistent prenatal care since adolescents are at increased risk of complications during pregnancy signs of preeclampsia arent a main teaching point until around week 20 (later on)
where should a car seat be installed in a car?
in back seat in the center (away from doors) if possible do not put the baby in sleep sack or blanket under the straps
why do ppl get IV albumin after a paracentesis to drain ascites?
to prevent hypotension and tachycardia - check VS
erikson stage for infants, toddlers, and preschoolers
trust vs mistrust autonomy vs shame/doubt initiative vs guilt
for someone who is hospitalized and bedbound while receiving brachytherapy, what should nurse do with their linens and trash?
they must remain in the room until radioactive implant is removed
how long should cervical cap remain in place after sex to work and kill sperm?
≥6 hours after sex; but not longer than 24 h
normal Cr
0.5-1.2 sign of kidney injury
what is therapeutic digoxin level?
0.8-2
how long does it take for glargine insulin to peak/when is patient most at risk for hypoglycemia?
3-14 hours
TPA after stroke must be given within what time period?
3-4 hours of symptoms starting sx: unilateral weakness, facial drooping, slurred speech
what is a normal troponin level?
<0.5
what are some specific criteria for caring for someone undergoing brachytherapy?
-limit the time of exposure (30min a day) -maximize distance from source -wear lead apron -turning back from client is risk for exposure
if we suspect a DVT in a patient, do we do Homan's sign?
NO - do not have patient dorsiflex and flex foot if we are trying to prevent DVT, you should tell them to flex and point feet while in bed
what is normal platelet count?
150,000-400,000
signs of preeclampsia
2+ pitting pedal edema, 300mg/24 protein in urine, headache and blurry vision, urine dipstick 1+, cerebral or visual sx, pulmonary edema
how long does it take for regular insulin to peak/when is patient most at risk for hypoglycemia?
2-5 hours
after restraints are on, how often should you reassess for need? how often should you remove restraints and do ROM exercises?
every hour every 2 hours
whenever mentions antipsychotic medication, what type of symptoms should you look out for?
extrapyramidal symptoms like restlessness, fidgeting, tremors, shuffling gait, pill rolling, mask like facies, agitation also anticholinergic and sedation
if you are giving client nitro IV for unstable angina and they have relief of pain but complain of headache what should you do?
give acetaminophen and document finding - do not slow down infusion rate HA is expected
in a sickle cell crisis, what is priority intervention first?
giving IV fluids
what are the signs of hyperglycemia to be on the lookout for in someone receiving TPN?
polydipsia, polyuria, headaches, blurred vision
why should client with constipation avoid caffeinated beverages?
promote diuresis, which may lead to dehydration and worsen constipation
if a patient who needs CPR needs AED is wearing a transdermal medication patch, what should you do?
remove transdermal patch before using AED
what are early signs of hypovolemic shock?
tachypnea, hypotension, pallor, tachycardia, anxiety, restlessness, confusion, oliguria
what is the main possible adverse effect of PEEP?
tension pneumothorax
if someone is on intermittent tube feeding and you get gastric residual of >100-250, what should you do?
you should hold or stop the feeding AND NO NOT REFEED RESIDUAL
in countries with high rates of TB, what vaccine do ppl get that often produces false positive TB skin test readings? what should you do as nurse?
Calmette-Guerin vaccine should do chest Xray if no symptoms of TB
what can increased itching in palms of hands of pregnant woman mean?
HELLP - Hemolysis RBCs, elevated Liver enzymes, low platelets
what does uterine tachysystole look like?
More than 5 contractions in 10 mins and each lasts longer than 90 secs
every pulseless individual gets _______
epinephrine
what is a pleural effusion?
accumulation of fluid in the pleural space
what are nursing interventions to reduce ICP?
administer stool softener dim lights when not providing care maintain body in midline position only perform oral suctioning when needed avoid extreme neck flexion keep calm environment
what are the physical manifestations of emphysema?
barrel chest, activity intolerance, hyperresonance on percussion
what is the #1 concern with cirrhosis of liver?
bleeding - low clotting factors
after blood has arrived on unit for transfusion, how long can it be on unit before it has to be sent back to lab if unused?
can only be out of lab for 30 mins; if longer than you need to send it back to blood bank bc they have the right type of refrigerator
what are PVCs caused by and what should you do if detected on cardiac monitor?
caused by hypoxia, electrolyte imbalances, stress, stimulants, fever, exercise if labs show hypokalemia then give potassium
foods low in potassium (for someone with end stage renal disease)
chicken, apples, grapefruit, turkey, corn, green peas, cucumber, white flour/rice, onion, asparagus
what are late signs of hypovolemic shock?
cold moist skin, cyanosis, weak thready pulses, anuria, hypotension, metabolic acidosis (lactic acid)
what should you do if you are transporting a patient and their chest tube becomes disconnected?
cover insertion site with clean gloved hand
abruptio placentae looks like
dark red bleeding, boardlike abdomen, PAIN would see late deccels - look at fetal monitor
you are turning a patient you is sedated and intubated, they cough and endotracheal tube is expelled, what should you do first???
deliver rescue breathing and 100 O2 with non-rebreather bag valve mask accidental extubation is a medical emergency, a sedated patient is unable to protect airway
describe the pain with pyelonephritis
dull flank pain, extending to umbilicus
what labs would you expect in cirrhosis of liver?
elevated LFTS, elevated ammonia, elevated bilirubin low albumin and low clotting factors
patient is brain dead and is an organ donor. family is worried about having an open casket, what should nurse say?
once body is dressed there will be no evidence of organ donation and open casket will be fine
is it an expected finding of a PEG tube to move 0.2cm when client coughs
yes
